Persistently raised C-reactive protein levels are associated with advanced periodontal disease

Objective: The aim was to investigate whether there was an association between periodontitis or tooth loss in a homogeneous group of 60-70-year-old Western European men and either a sustained high or low level of C-reactive protein (CRP).
Material and Methods: Men enrolled in a cohort study of cardiovascular disease in Northern Ireland were screened in 1990-1994 and rescreened in 2001-2004, when a periodontal examination was completed. High-sensitivity CRP was measured from fasting blood samples. There were 806 men with six or more teeth who had either a high level (>3 mg/l) or a lower level of CRP at both time points. Multivariate analysis was carried out using logistic regression with adjustment for possible confounders. Models were constructed with the CRP level as the outcome variable and various measures of periodontal status (low and high threshold periodontitis) or tooth loss as predictor variables. Confounders included in the analysis were known cardiovascular risk factors of age, smoking, diabetes, BMI and socioeconomic status.
Results: There were 67 men who had a high value of CRP (>3 mg/l) and 739 men who had a CRP value =3 mg/l at both time points. The unadjusted odds ratio (OR) for advanced periodontitis to be associated with high CRP was 3.62, p=0.0003. The association was somewhat attenuated but remained significant (OR=2.49, p=0.02) after adjustment for confounders. A high level of tooth loss was also associated with high CRP with an adjusted OR of 2.17, p=0.008. Low threshold periodontitis was not associated with the level of CRP.
Conclusion: There was an association between advanced periodontitis and elevated CRP levels as measured at two time points at a 10-year interval in the 60-70-year-old European males investigated. This association was adjusted for various cardiovascular risk factors. There was also an association between high levels of tooth loss and high CRP in the men studied.

Oesophageal cancer: caregiver mental health and strain

Objective: To investigate strain and mental health among family caregivers of oesophageal cancer patients and possible factors associated with caregiver mental health and strain.

Methods: Patients with oesophageal adenocarcinoma in Ireland were recruited into the FINBAR study (the main aim of which was to investigate factors influencing the Barrett's adenocarcinoma relationship). Carers completed the 13-item Caregiver Strain Index and the General Health Questionnaire-30 (GHQ) in the context of a brief interview with trained research staff that was undertaken separately from the interview with each cancer patient.

Results: Two hundred and twenty-seven patients participated in the FINBAR study. A total of 39 patients did not have a family carer or the carer could not be identified. Fifty percent (94/188) of carers completed the questionnaires. Mean (SD) scores for strain (6.65, SD=3.63) and mental health status (10.21, SD=7.30) were high and 71% of carers scored >5 on the GHQ indicating psychological distress. There was a statistically significant positive relationship between level of strain experienced by caregivers and the severity of their mental health status and whether or not carers scored >5 on the GHQ. Relatives were 1.70 (95% CI 1.34-2.15) times more likely to be defined as high scorers with each unit increase in the CSI score.

Conclusions: A significant proportion of caregivers experienced high levels of strain and psychological distress. There is a need to provide appropriate support and services targeted specifically at reducing the considerable strain of caring for patients with oesophageal cancer, particularly for carers of patients from lower socioeconomic groups.

Authenticity and stakeholder planning in the segregated city

This paper is concerned with the production and reproduction of segregation in Northern Ireland and how territoriality has impacted on the Protestant community in Derry/Londonderry. The city was pivotal in the development of the most recent conflict, has a majority Catholic population, sits on a contested border and has attempted to respond to expressions of alienation that have emerged from the Protestant community. The research used multiple methods to understand the nature of alienation and exclusion using secondary data, a quantitative household survey, in-depth interviews and focus
groups. This empirical commitment was important in identifying and unpacking the claims of various stakeholders with an interest in the use and development of the area. It is argued here that a version of Collaborative Planning provides a loosely articulated conceptual and methodological framework for drawing Protestant communities into the wider planning framework for the city. The data, however, suggest that the nature of stakeholders is complex and contradictory, and discursive practice that seeks consensus has limits, especially in validating or legitimating the assertions of self-acclaimed stakeholders. The research shows that the Protestant community had declined and residualised but had little experience of direct conflict with the majority community. Moreover, the Protestant community is now more likely to use the city centre (a predominantly Catholic space) for consumption and work, and its demographic decline has stopped. These findings are important as policy responses and community relations programmes have failed to distinguish between measurable socioeconomic needs and claims concerning ethnic alienation based on emotion and manipulation. Such alienation has tended to bolster single identity communities who have little or no prospect and/or knowledge of the collaborative efforts required to deliver meaningful regeneration. More realistic strategies based on agonism focus attention on power relations and the authenticity of positions adopted by competing interests in land use management and change. The paper concludes by highlighting the need to acknowledge and value contestation but to challenge sectarian discourses represented as legitimate claims about community needs and priorities.

Making hay while the sun shines? Socio-economic change, cereal production and climatic deterioration in Early Medieval Ireland

The Early Medieval period in Ireland (c. A.D. 400–1150) has been the subject of much archaeological and historical study. The recent application of various forms of archaeological sciences, as well as palaeoenvironmental studies, to the archaeological record have, however, added fresh impetus to this study area. It seems increasingly evident that significant changes to economy and society occurred during this period and were not recorded in detail in the contemporary documentary sources. This paper will attempt to outline those changes and to assess whether, or to what extent, they were influenced by climate change.

‘Hearing Voices': Punishing women’s mental ill-health in Northern Ireland’s jails

Informed by primary interviews and observational research conducted by the authors with women prisoners in Northern Ireland, this article focuses on prison as an institutional manifestation of women’s powerlessness and vulnerability, particularly those enduring mental ill-health. It contextualises their experiences within continua of violence and ‘unsafety’. It also considers official responses to critical inspection reports and those of the Northern Ireland Human Rights Commission based on the authors’ research findings. Finally, the primary research demonstrates that three decades on from publication the first critical analyses of women’s imprisonment, the conditions of gendered marginalisation, medicalisation and punishment remain. This is brought into stark relief in the punitive regimes imposed on those most vulnerable through mental ill-health.